Provider Demographics
NPI:1528748399
Name:HAWTHORNE, RONISHA (OTA)
Entity type:Individual
Prefix:
First Name:RONISHA
Middle Name:
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 LOQUAT RD NW
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-6541
Mailing Address - Country:US
Mailing Address - Phone:863-243-0965
Mailing Address - Fax:
Practice Address - Street 1:272 LOQUAT RD NW
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-6541
Practice Address - Country:US
Practice Address - Phone:863-243-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA14074225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology